Capnography rapidly confirmed correct endotracheal tube placement during resuscitation of extremely low birthweight babies (< 1000 g)

Abstract

During neonatal resuscitation, the routine use of capnography to verify correct placement of the endotracheal tube is not an established international practice. We present four cases that illustrate the successful use of immediate capnography to verify correct tracheal tube placement even in extremely low birthweight (ELBW) prematures (< 1000 g) during resuscitation. Based on this limited experience, we reached institutional consensus among paediatricians and anaesthesiologists that capnography should become standard monitoring during all endotracheal intubations in premature babies.

Tidal Volume Threshold for Colorimetric Carbon Dioxide Detectors Available for Use in Neonates

“…[3][4][5][6][7][8][10][11][12] In a neonatal population that included infants who weighed Ͻ1000 g, Aziz et al 3 compared the colorimetric CO 2 detector with clinical evaluation to confirm endotracheal intubation in the delivery room and the NICU. They found that the CO 2 detector decreased the time needed to determine endotracheal tube position from a mean of 39.7 seconds (SD: Ϯ15.3 seconds) to a mean of 8.1 second (SD: Ϯ2.9 seconds).…”

“…Current methods for confirming intubation include direct visualization of the endotracheal tube passing through the vocal cords, inspection of chest wall movement, auscultation of breath sounds, condensation on the endotracheal tube during expiration, and more recently end-tidal carbon dioxide (ETCO 2 ) detection. [3][4][5][6][7][8][9][10][11][12] In the Fifth Edition revised Neonatal Resuscitation Program (NRP) guidelines, increasing heart rate and exhaled CO 2 detection including colorimetric CO 2 detectors are the primary methods recommended for confirmation of endotracheal intubation in infants 13 ; however, current product labeling of colorimetric CO 2 detectors recommends use for infants and small children who weigh Ͼ1 kg and Ͻ15 kg.Colorimetric CO 2 detectors are a semiquantitative, noninvasive method to evaluate ETCO 2 and demonstrate breath-to-breath color change after successful intubation. In addition, we have shown that these devices are useful in determining whether the airway is patent during bag and mask ventilation.…”

Part 10: Pediatric Basic and Advanced Life Support

“…Two additional neonatal LOE 5 studies 162,163 showed that confirmation of tracheal tube position is faster with capnography than with clinical assessment.…”

Current methodological and technical limitations of time and volumetric capnography in newborns

“…In addition, special low-flow sidestream capnographs were developed for dead space free measurements in neonates, making long-term monitoring possible [15–17]. Several clinical studies have shown the clinical benefit of the time-based capnography in ventilated infants and children, e.g., for non-invasive monitoring of the arterial pCO 2 [18–20], to verify endotracheal tube placement [21–23], and to monitor the integrity of the ventilator circuit including disconnection and accidental extubation [24–26]. In spontaneously breathing infants time-based and volumetric capnography has been used for assessment of functional lung alterations related to bronchopulmonary dysplasia (BPD) [27–29].…”